Incidence and clinical characteristics of group A rotavirus infections among children admitted to hospital in Kilifi, Kenya.

<h4>Background</h4>Rotavirus, predominantly of group A, is a major cause of severe diarrhoea worldwide, with the greatest burden falling on young children living in less-developed countries. Vaccines directed against this virus have shown promise in recent trials, and are undergoing effe...

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Autores principales:	D James Nokes, John Abwao, Allan Pamba, Ina Peenze, John Dewar, J Kamino Maghenda, Hellen Gatakaa, Evasius Bauni, J Anthony G Scott, Kathryn Maitland, Thomas N Williams
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2008
Materias:	Medicine R
Acceso en línea:	https://doaj.org/article/3551951096c74529b42a95eb8f3f3b32
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spelling	oai:doaj.org-article:3551951096c74529b42a95eb8f3f3b322021-11-25T05:36:52ZIncidence and clinical characteristics of group A rotavirus infections among children admitted to hospital in Kilifi, Kenya.1549-12771549-167610.1371/journal.pmed.0050153https://doaj.org/article/3551951096c74529b42a95eb8f3f3b322008-07-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/18651787/?tool=EBIhttps://doaj.org/toc/1549-1277https://doaj.org/toc/1549-1676<h4>Background</h4>Rotavirus, predominantly of group A, is a major cause of severe diarrhoea worldwide, with the greatest burden falling on young children living in less-developed countries. Vaccines directed against this virus have shown promise in recent trials, and are undergoing effectiveness evaluation in sub-Saharan Africa. In this region limited childhood data are available on the incidence and clinical characteristics of severe group A rotavirus disease. Advocacy for vaccine intervention and interpretation of effectiveness following implementation will benefit from accurate base-line estimates of the incidence and severity of rotavirus paediatric admissions in relevant populations. The study objective was to accurately define the incidence and severity of group A rotavirus disease in a resource-poor setting necessary to make informed decisions on the need for vaccine prevention.<h4>Methods and findings</h4>Between 2002 and 2004 we conducted prospective surveillance for group A rotavirus infection at Kilifi District Hospital in coastal Kenya. Children < 13 y of age were eligible as "cases" if admitted with diarrhoea, and "controls" if admitted without diarrhoea. We calculated the incidence of hospital admission with group A rotavirus using data from a demographic surveillance study of 220,000 people in Kilifi District. Of 15,347 childhood admissions 3,296 (22%) had diarrhoea, 2,039 were tested for group A rotavirus antigen and, of these, 588 (29%) were positive. 372 (63%) rotavirus-positive cases were infants. Of 620 controls 19 (3.1%, 95% confidence interval [CI] 1.9-4.7) were rotavirus positive. The annual incidence (per 100,000 children) of rotavirus-positive admissions was 1,431 (95% CI 1,275-1,600) in infants and 478 (437-521) in under-5-y-olds, and highest proximal to the hospital. Compared to children with rotavirus-negative diarrhoea, rotavirus-positive cases were less likely to have coexisting illnesses and more likely to have acidosis (46% versus 17%) and severe electrolyte imbalance except hyponatraemia. In-hospital case fatality was 2% among rotavirus-positive and 9% among rotavirus-negative children.<h4>Conclusions</h4>In Kilifi > 2% of children are admitted to hospital with group A rotavirus diarrhoea in the first 5 y of life. This translates into over 28,000 vaccine-preventable hospitalisations per year across Kenya, and is likely to be a considerable underestimate. Group A rotavirus diarrhoea is associated with acute life-threatening metabolic derangement in otherwise healthy children. Although mortality is low in this clinical research setting this may not be generally true in African hospitals lacking rapid and appropriate management.D James NokesJohn AbwaoAllan PambaIna PeenzeJohn DewarJ Kamino MaghendaHellen GatakaaEvasius BauniJ Anthony G ScottKathryn MaitlandThomas N WilliamsPublic Library of Science (PLoS)articleMedicineRENPLoS Medicine, Vol 5, Iss 7, p e153 (2008)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R
spellingShingle	Medicine R D James Nokes John Abwao Allan Pamba Ina Peenze John Dewar J Kamino Maghenda Hellen Gatakaa Evasius Bauni J Anthony G Scott Kathryn Maitland Thomas N Williams Incidence and clinical characteristics of group A rotavirus infections among children admitted to hospital in Kilifi, Kenya.
description	<h4>Background</h4>Rotavirus, predominantly of group A, is a major cause of severe diarrhoea worldwide, with the greatest burden falling on young children living in less-developed countries. Vaccines directed against this virus have shown promise in recent trials, and are undergoing effectiveness evaluation in sub-Saharan Africa. In this region limited childhood data are available on the incidence and clinical characteristics of severe group A rotavirus disease. Advocacy for vaccine intervention and interpretation of effectiveness following implementation will benefit from accurate base-line estimates of the incidence and severity of rotavirus paediatric admissions in relevant populations. The study objective was to accurately define the incidence and severity of group A rotavirus disease in a resource-poor setting necessary to make informed decisions on the need for vaccine prevention.<h4>Methods and findings</h4>Between 2002 and 2004 we conducted prospective surveillance for group A rotavirus infection at Kilifi District Hospital in coastal Kenya. Children < 13 y of age were eligible as "cases" if admitted with diarrhoea, and "controls" if admitted without diarrhoea. We calculated the incidence of hospital admission with group A rotavirus using data from a demographic surveillance study of 220,000 people in Kilifi District. Of 15,347 childhood admissions 3,296 (22%) had diarrhoea, 2,039 were tested for group A rotavirus antigen and, of these, 588 (29%) were positive. 372 (63%) rotavirus-positive cases were infants. Of 620 controls 19 (3.1%, 95% confidence interval [CI] 1.9-4.7) were rotavirus positive. The annual incidence (per 100,000 children) of rotavirus-positive admissions was 1,431 (95% CI 1,275-1,600) in infants and 478 (437-521) in under-5-y-olds, and highest proximal to the hospital. Compared to children with rotavirus-negative diarrhoea, rotavirus-positive cases were less likely to have coexisting illnesses and more likely to have acidosis (46% versus 17%) and severe electrolyte imbalance except hyponatraemia. In-hospital case fatality was 2% among rotavirus-positive and 9% among rotavirus-negative children.<h4>Conclusions</h4>In Kilifi > 2% of children are admitted to hospital with group A rotavirus diarrhoea in the first 5 y of life. This translates into over 28,000 vaccine-preventable hospitalisations per year across Kenya, and is likely to be a considerable underestimate. Group A rotavirus diarrhoea is associated with acute life-threatening metabolic derangement in otherwise healthy children. Although mortality is low in this clinical research setting this may not be generally true in African hospitals lacking rapid and appropriate management.
format	article
author	D James Nokes John Abwao Allan Pamba Ina Peenze John Dewar J Kamino Maghenda Hellen Gatakaa Evasius Bauni J Anthony G Scott Kathryn Maitland Thomas N Williams
author_facet	D James Nokes John Abwao Allan Pamba Ina Peenze John Dewar J Kamino Maghenda Hellen Gatakaa Evasius Bauni J Anthony G Scott Kathryn Maitland Thomas N Williams
author_sort	D James Nokes
title	Incidence and clinical characteristics of group A rotavirus infections among children admitted to hospital in Kilifi, Kenya.
title_short	Incidence and clinical characteristics of group A rotavirus infections among children admitted to hospital in Kilifi, Kenya.
title_full	Incidence and clinical characteristics of group A rotavirus infections among children admitted to hospital in Kilifi, Kenya.
title_fullStr	Incidence and clinical characteristics of group A rotavirus infections among children admitted to hospital in Kilifi, Kenya.
title_full_unstemmed	Incidence and clinical characteristics of group A rotavirus infections among children admitted to hospital in Kilifi, Kenya.
title_sort	incidence and clinical characteristics of group a rotavirus infections among children admitted to hospital in kilifi, kenya.
publisher	Public Library of Science (PLoS)
publishDate	2008
url	https://doaj.org/article/3551951096c74529b42a95eb8f3f3b32
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Incidence and clinical characteristics of group A rotavirus infections among children admitted to hospital in Kilifi, Kenya.

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